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Frequently asked questions on migration and health

Online Q&ASeptember 2015

Abridged WHO/Europe FAQ *

Q: What are the common health problems of refugees and migrants arriving in the European Region?

A: The health problems of refugees and migrants are similar to those of the rest of the population, although some groups may have a higher prevalence. The most frequent health problems of newly arrived migrants include accidental injuries, hypothermia, burns, cardiovascular events, pregnancy and delivery-related complications, diabetes and hypertension. Female migrants frequently face specific challenges, particularly in maternal, newborn and child health, sexual and reproductive health, and violence.

The exposure of migrants to the risks associated with population movements – psychosocial disorders, reproductive health problems, higher newborn mortality, drug abuse, nutrition disorders, alcoholism and exposure to violence – increase their vulnerability to noncommunicable diseases (NCDs). The key issue with regard to NCDs is the interruption of care, due either to lack of access or to the decimation of health care systems and providers; displacement results in interruption of the continuous treatment that is crucial for chronic conditions.

Vulnerable children are prone to acute infections such as respiratory infections and diarrhoea because of poor living conditions and deprivation during migration, and they require access to acute care. Lack of hygiene can lead to skin infections. Furthermore, the number of casualties and deaths among refugees and migrants crossing the Mediterranean Sea has increased rapidly, with a reported 1867 people drowned or missing at sea in the first 6 months of 2015, according to the United Nations High Commissioner for Refugees (UNHCR).

Q: What are the WHO recommendations for triage and screening of migrants upon arrival?

A: WHO does not recommend obligatory screening of refugee and migrant populations for diseases, because there is no clear evidence of benefits (or cost-effectiveness); furthermore, it can trigger anxiety in individual refugees and the wider community.

WHO strongly recommends offering and providing health checks to ensure access to health care for all refugees and migrants in need of health protection. Health checks should be done for both communicable and NCDs, with respect for migrants' human rights and dignity.

The results of screening must never be used as a reason or justification for ejecting a refugee or a migrant from a country.

Obligatory screening deters migrants from asking for a medical check-up and jeopardizes identification of high-risk patients.

In spite of the common perception that there is an association between migration and the importation of infectious diseases, there is no systematic association. Refugees and migrants are exposed mainly to the infectious diseases that are common in Europe, independently of migration. The risk that exotic infectious agents, such as Ebola virus, will be imported into Europe is extremely low, and when it occurs, experience shows that it affects regular travellers, tourists or health care workers rather than refugees or migrants.

Triage is recommended at points of entry to identify health problems in refugees and migrants soon after their arrival. Proper diagnosis and treatment must follow, and the necessary health care must be ensured for specific population groups (children, pregnant women, elderly).

Each and every person on the move must have full access to a hospitable environment, to prevention (e.g. vaccination) and, when needed, to high-quality health care, without discrimination on the basis of gender, age, religion, nationality or race. This is the safest way to ensure that the resident population is not unnecessarily exposed to imported infectious agents. WHO supports policies to provide health care services to migrants and refugees irrespective of their legal status as part of universal health coverage.

Q: What does WHO recommend with regard to vaccination for newly arrived migrants?

A: Transmission of vaccine-preventable diseases to host country populations is just as likely to happen after the return of a resident of that country from a holiday in an endemic country as after the arrival of a migrant from the country. There are still large gaps in the immunity of populations across the Region, either because countries decide not to avail themselves of the benefits of vaccination or because of limited access to vaccination services.

The WHO Regional Office for Europe does not routinely collect information on transmission of vaccine-preventable diseases among migrants or on their immunization coverage. However, well-documented outbreaks of measles have originated by transmission from migrants, mobile populations, international travellers and tourists alike.

Equitable access to vaccination is of prime importance and is one of the objectives of the European Vaccine Action Plan 2015–2020. The plan proposes that all countries in the Region pay special attention to ensuring the eligibility and access of migrants, international travellers and marginalized communities to (culturally) appropriate vaccination services and information. We applaud the many countries, such as those receiving large influxes of migrants, that are including migrants into their routine vaccination programmes.

Q: What health care access does WHO recommend for refugees and migrants?

A: Legal status is one of the most important determinants of the access of migrants to health services in a country. Each and every refugee and migrant must have full, uninterrupted access to a hospitable environment and, when needed, to high-quality health care, without discrimination on the basis of gender, age, religion, nationality or race. WHO supports policies to provide health care services irrespective of migrants' legal status. As rapid access to health care can result in cure, it can avoid the spread of diseases; it is therefore in the interest of both migrants and the receiving country, to ensure that the resident population is not unnecessarily exposed to the importation of infectious agents. Likewise, diagnosis and treatment of NCDs such as diabetes and hypertension can prevent these conditions from worsening and becoming life-threatening.

Q: What is WHO doing to address the public health implications of the large influxes of refugees and migrants into the European Region?

A: WHO works to:

develop migrant-sensitive health policies;

strengthen health systems to provide equitable access to services;

establish information systems to assess migrant health;

share information on best practices;

increase the cultural and gender sensitivity and specific training of health service providers and professionals;

and promote multilateral cooperation among countries in accordance with resolution WHA61.17 on the health of migrants endorsed by the Sixty-first World Health Assembly in 2008.

WHO has been working on the health issues related to people's movements for many years. The WHO European health policy framework Health 2020 has drawn particular attention to migration and health, with population vulnerability and human rights. Following the political, economic and humanitarian crises in the north of Africa and the Middle East, WHO, in collaboration with the Italian Ministry of Health, established the Public Health Aspects of Migration in Europe project in April 2012. The aims are:

to strengthen health system capacity to meet the health needs of mixed inflows of migrants and host populations;

promote immediate health interventions;

ensure migrant-sensitive health policies;

improve the quality of the health services delivered;

and optimize use of health structures and resources in countries receiving migrant populations.

Up to August 2015, the Regional Office had conducted joint assessment missions with ministries of health in Bulgaria, Cyprus, Greece, Italy, Malta, Portugal, Serbia and Spain, with the new "Toolkit for assessing health system capacity to manage large influxes of migrants in the acute phase," to respond to and address the complex, resource-intensive, multisectoral, politically sensitive issues in health and migration.